Provider Demographics
NPI:1275828956
Name:BAUTISTA, JOSSIE M (LND,RD)
Entity Type:Individual
Prefix:MRS
First Name:JOSSIE
Middle Name:M
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:LND,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0079
Mailing Address - Country:US
Mailing Address - Phone:787-245-9446
Mailing Address - Fax:
Practice Address - Street 1:51 CALLE FLOR GERENA S
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4207
Practice Address - Country:US
Practice Address - Phone:787-245-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR669133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered